The first deadline has passed, but it's not too late for health insurance

Monday

Dec 30, 2013 at 12:01 AMDec 30, 2013 at 4:00 AM

By Jenny WagnerCalkins Media

Even after 11:30 p.m. Dec. 23, Erin Ninehouser and her colleagues at Pennsylvania Health Access Network were still getting calls from people trying to sign up for health insurance before the midnight cutoff for coverage to take effect Jan. 1.

The Obama administration extended the deadline by another day, meaning Ninehouser, a certified application counselor who helps people navigate the Affordable Care Act health insurance marketplace, was able to get some last-minute shoppers signed up on Christmas Eve, but some people were still scrambling.

Although people who missed last week’s deadline won’t have insurance starting at the beginning of the year, Ninehouser said it doesn’t mean it’s too late to sign up. And for those who did get through the enrollment process in time, she recommends taking a few extra steps now to make sure everything goes off without a hitch on Wednesday.

Ninehouser said the first thing new enrollees should do is verify their coverage and payment due dates.

“The last screen you see when you’ve successfully enrolled is the phone number for whatever insurance company you picked, so definitely get in touch with them and see that you enrolled completely and see what their deadline is for payment for Jan. 1 coverage,” said Ninehouser, the education and outreach director for PHAN and one of the organization’s three application counselors.

Most insurance companies are accepting payment for the first monthly premium until Jan. 10, Ninehouser said, but it’s best to check on the individual plan.

The initial enrollment period will remain open until March 31, so people can still sign up for health insurance any time between now and then. If enrollment is completed before the 15th of each month, coverage will begin on the first of the following month, Ninehouser explained.

“Aim for the first 15 days of the month so that way you don’t have to spend another 30 days uninsured,” she said.

Once open enrollment ends, individuals can sign up for insurance only if they experience a life event that would qualify for a special enrollment period.

“There’s a number of things that can happen,” Ninehouser said, naming a few, such as losing or getting a job with health insurance, becoming eligible for Medicare, adopting a child or getting married. “Basically if your health coverage status changes … you have a 60-day window (to enroll).”

Ninehouser pointed out that for people on temporary health insurance through COBRA, the Consolidated Omnibus Budget Reconciliation Act, dropping out of coverage is not considered a qualifying event — only when the benefits expire on their own will it trigger a special enrollment period. For individuals on COBRA who may need to discontinue their plans during the year, Ninehouser advised doing it before March 31 to avoid losing coverage altogether.

The next open enrollment period is from Nov. 15 to Jan. 15, 2015.

For those who opt not to enroll in health insurance, some will face a penalty, which in the first year is $95 or 1 percent of an individual’s taxable income, due in the spring of 2015 during tax time.

Individuals only have to pay the penalty if they don’t qualify for an exemption, Ninehouser explained. There are 13 exemptions, which include financial reasons such as if the lowest price option for health insurance is more than 8 percent of a person’s household income, or if an individual makes less than 100 percent of the federal poverty level, but makes too much to qualify for medical assistance.

In Pennsylvania, there are about 300,000 people who fall into that income gap who are not eligible for ACA subsidies or Medicaid, Ninehouser said.

For people who have no income when applying for insurance, but who think they will get a job or make more than 100 percent of the poverty level during the next year, Ninehouser advised estimating the amount and entering that because putting a zero into the HealthCare.gov applications will mean not qualifying for a tax subsidy.

If their actual income is different or changes during the year, it can be updated through the marketplace so they can take full advantage of available credits and also so they do not owe money for underestimating, Ninehouser explained.

The online marketplaces allow individuals to shop now and see estimated subsidies, which Ninehouser said have been very accurate recently.

“The window shopping tool on HealthCare.gov is now really excellent,” she said.

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